Knowledge and Awareness of Glaucoma Among People Living in Taif City in the Western Region of Saudi Arabia

Background Glaucoma represents a significant global health challenge, characterized by progressive and irreversible optic nerve damage, visual field impairment, and potential blindness. Limited awareness can lead to delayed diagnosis and increased healthcare burden. This research explored glaucoma awareness in Taif City, Saudi Arabia. It delved into the influence of demographics, socioeconomic factors, and cultural beliefs on awareness. The study aimed to inform tailored awareness campaigns and policy decision-makers about regional awareness, ultimately contributing to effective healthcare initiatives in the region. Methodology A cross-sectional study was conducted in Taif City including adults (>18 years) using a community-based approach. Data were collected using an electronic questionnaire. Results This study included 1,000 participants. Most participants were males, aged 18-29 years, with 51.1% (n = 511) having at least a bachelor’s education. The media (n = 341, 34.1%) and relatives/friends (n = 336, 33.6%) were common sources of glaucoma information. Among all participants, 58.5% (n = 585) had heard of glaucoma, and many were uncertain about glaucoma’s definition and normal eye pressure values. About 63.1% (n = 631) believed in a cure, and 43.1% thought vision loss could be restored. Gender, education, and family history significantly influenced awareness. Closed-angle glaucoma (n = 297, 29.7%) and open-angle glaucoma (n = 231, 23.1%) were recognized types, with surgery (n = 371, 37.1%) and laser treatment (n = 274, 27.4%) perceived as potential cures. Conclusions This study revealed glaucoma awareness among adults in Taif City. Gender, education, and family history played significant roles in shaping awareness levels. There is a need for targeted educational efforts to improve knowledge about glaucoma in the community.


Introduction
Glaucoma, an intricate group of ocular disorders, represents a significant global health challenge, characterized by progressive and irreversible optic nerve damage, visual field impairment, and potential blindness [1].Glaucoma, a silent but devastating eye disease, poses a substantial threat to global eye health [2].Its multifactorial etiology encompasses variables such as genetics, age, intraocular pressure, family history, and race [3].Swift diagnosis, timely intervention, and effective management stand as pivotal factors in mitigating irreversible vision loss caused by this insidious condition [4].
Global disparities in glaucoma awareness are a pressing concern, with significant differences observed among various geographical regions and populations [5].It is crucial to emphasize the importance of heightened awareness, especially with the given asymptomatic nature of the disease.Soqia et al. (2023) conducted a comprehensive study that shed light on the widespread lack of awareness, which, in turn, contributed to the alarming prevalence of undiagnosed glaucoma cases around the world [6].awareness within the intricate tapestry of Taif City.Nestled in the heart of western Saudi Arabia, this urban center encapsulates a dynamic amalgamation of individuals, each contributing a distinctive set of perspectives, beliefs, and lifestyles influenced by health literacy [7,8], social media platforms [9], educational backgrounds [10], cultural beliefs [11], and access to healthcare resources [12,13].
The investigation of glaucoma awareness in this context becomes an essential endeavor to address potential disparities in knowledge dissemination and to chart a course for targeted health education initiatives.Further, a critical aspect of glaucoma awareness research involves evaluating the efficacy of the ongoing awareness campaigns [14].Assessing the outcomes of previous initiatives, such as those which were conducted by Saudi organizations such as the Saudi Glaucoma Society, can provide insights into which approaches have worked and which aspects need refinement.
In Taif, like many other places, limited knowledge about glaucoma's subtle progression and potentially irreversible damage hinders early diagnosis, adequate management, and treatment initiation [15,16].These intricate variables collectively impact the awareness landscape regarding glaucoma and its underlying risk factors [17].Addressing these awareness gaps can significantly impact the management of glaucoma and potentially prevent irreversible vision loss.
Hence, this study aimed to assess the current level of awareness and knowledge of glaucoma; identify the main sources of information about glaucoma; determine the accuracy of understanding regarding the definition, symptoms, and risk factors of glaucoma; and examine the perception of glaucoma as a treatable and preventable condition.In addition, this study also aimed to analyze any associations between demographic factors (such as age, gender, and education level) and glaucoma awareness among the Taif City population.
The significance of this research extends beyond mere statistical enumeration.By scrutinizing not only the percentage of individuals cognizant of glaucoma but also delving into the nuanced fabric of understanding, misconceptions, and attitudes that underlie this awareness, the study endeavors to construct a comprehensive narrative.By painting a comprehensive portrait of glaucoma awareness within Taif City [18], the study not only contributes to the scientific literature but also empowers healthcare practitioners, policymakers, and educators with the insights required to curate effective and culturally sensitive awareness initiatives.

Study design and location
A cross-sectional study was conducted in Taif City adopting a community-based approach.

Inclusion and exclusion criteria
The study included both male and female adults (>18 years old) residing in Taif City.Individuals below 18 years of age and those who did not reside in Taif City were excluded from the study.

Sample size
To ensure the reliability of the study outcomes, the sample size necessary for investigating glaucoma awareness in Taif City was determined using the EPI Info program.Employing a 95% confidence level and a 5% margin of error, around 384 participants were required.By considering the likelihood of a 10% nonresponse rate, the sample size was adjusted to 426 participants.

Study questionnaire and sampling technique
An electronic questionnaire was utilized as the primary data collection tool.The e-questionnaire was distributed electronically through different platforms (Twitter, WhatsApp, Telegram, emails, and others).In addition to sociodemographic inquiries, 10 questions were posed to test participants' awareness of glaucoma.A random sampling technique was used to select participants, and then final participants were included based on inclusion criteria and removed based on exclusion criteria.

Ethical considerations
The ethical aspects of this study were overseen by the Scientific Research Ethics Committee, Taif University on September 25, 2023 (reference number: 45-033).

Statistical analysis
Both descriptive and inferential statistical analysis of the data was performed.Simple frequencies and percentages of the sociodemographic characteristics of the participants and their perception, knowledge, and awareness about glaucoma were calculated and tabulated.Awareness was quantified by assigning a value of 1 to correct responses and a value of 0 to incorrect ones.These scores were then summed up, and individuals with more than 50% correct answers were considered to exhibit a substantial level of awareness.Chi-square/Fisher's exact test was used to determine the association between sociodemographic features and good/poor glaucoma awareness levels.Statistical significance was established at a p-value of 0.05 or less with a 95% confidence interval.All statistical calculations were performed using the SPSS Software version 29.0.0 (IBM Corp., Armonk, NY, USA).

Variables
Frequency  Participants' sources of information about glaucoma were diverse.The majority (n = 341, 34.1%) relied on the media industry for information.Around 33.6% (n = 336) obtained information from relatives and friends, while 22.1% (n = 221) consulted health practitioners (Figure 1).*: Correct answer.
Regarding age, no statistically significant difference was observed among different age groups with respect to awareness levels (p = 0.362).However, age groups between 40 and 60 years old were the most knowledgeable about the disease.Further, gender showed a strong association (p < 0.001), with women exhibiting higher awareness levels (n = 442, 44.2%) compared to men (n = 322, 32.2%).Educational level displayed a significant association (p = 0.044), with individuals having university or postgraduate degrees demonstrating the highest awareness (n = 413, 41.3%) than those with less education (25% (n = 250) for noneducated, 27.5% (n = 275) for those with elementary education, and 33.4% (n = 334) for those with secondary education).Employment status and marital status did not show significant associations with awareness.Moreover, the presence of diabetes, as a risk factor for glaucoma, did not significantly affect participants' awareness levels (p = 0.798).Notably, a family history of glaucoma exhibited a substantial association (p < 0.001) with awareness levels.Participants with a positive family history of glaucoma achieved higher awareness scores (n = 450, 45%) in comparison to those without the disease (n = 425, 42.5%) (Table 3).

Discussion
Glaucoma, a silent but devastating eye disease, poses a substantial threat to global eye health [2].Its multifactorial etiology encompasses variables such as genetics, age, intraocular pressure, family history, and race [3].Swift diagnosis, timely intervention, and effective management stand as pivotal factors in mitigating irreversible vision loss caused by this insidious condition [4].This study aimed to provide valuable insights into the awareness levels and knowledge about glaucoma among the people living in Taif City, Saudi Arabia.
Sociodemographic data revealed interesting patterns.The majority of women showed high awareness, suggesting that females exhibited a higher awareness of glaucoma compared to males [15].This finding emphasizes the need for targeted awareness of glaucoma among the Taif City population.
As the 18-29-year age group had the highest representation in glaucoma awareness assessment, it is essential to note that glaucoma primarily affects older individuals due to age-related risk.Awareness efforts should encompass all age groups, as even the young might be at risk and need further education [19].Thus, glaucoma awareness campaigns should be designed to reach individuals across all age groups.
Education plays a crucial role in awareness levels as 51.1% (n = 511) of participants had under or postgraduate education, while 44.8% (n = 448) had completed secondary school.Interestingly, the educational level did show a significant association with awareness (p = 0.044).Individuals with no education or those with elementary school degrees exhibited poorer awareness compared to those with secondary school or higher education [20].
Understanding the source of participants' information about glaucoma is essential for tailoring awareness campaigns.Most participants relied on the media industry for information, followed closely by those who obtained information from relatives and friends [21].This emphasizes the need for a diverse strategy in spreading glaucoma awareness, including media, social conversations, and healthcare professional involvement in education.
Regarding awareness level, 58.5% (n = 585) of participants were aware of glaucoma, indicating that a substantial proportion were unaware of the disease.To raise awareness, targeting those who are completely unaware is crucial [22].
Although family history is a significant glaucoma risk factor, 71.3% (n = 713) reported no family history of glaucoma.This underscores the importance of understanding one's family medical history and the need for regular eye examinations [23,24].
Knowledge about normal eye pressure values was limited, with 74.2% (n = 742) of unsure participants.This lack of knowledge can lead to misconceptions about glaucoma, which is often associated with damage to the optic nerve.Education should emphasize that glaucoma has more than one type and can occur even with normal eye pressure (OAG).
It is crucial to understand that glaucoma is symptomless until significant damage occurs.This study found that 44.1% of participants recognized symptoms such as progressive vision loss [25,26].However, there was uncertainty among 40.1% about whether glaucoma patients have symptoms or not.This highlights the need to educate the public about the "silent thief of sight" nature of glaucoma, where symptoms might not be apparent until irreversible damage occurs.
The majority (n = 631, 63.1%) believed glaucoma had a cure, and 43.1% (n = 431) thought lost sight could be restored.However, these optimistic beliefs might not align with reality.Education should stress early detection and management, although full vision restoration is not always guaranteed.
Participants' knowledge about potential cures for glaucoma is also noteworthy.The majority (n = 371, 37.1%) believed that surgery could cure glaucoma, while 27.4% (n = 274) perceived laser treatment as a curative option [28].Education should clarify that while these treatments can help manage glaucoma, there is no definitive cure, and ongoing monitoring is essential.
Finally, the associations between sociodemographic characteristics and glaucoma awareness reveal that gender showed a strong association, with women exhibiting higher awareness.A positive family history of glaucoma exhibited a significant association with awareness.This finding highlights the importance of targeting individuals with a family history of the disease for education and regular eye screenings.
The main limitation of this study is the potential selection bias as it focuses on a specific region (Taif City, Saudi Arabia) and might not represent broader populations.Moreover, the study used self-reported data susceptible to information bias.Its cross-sectional design hinders causal inference and might miss changes in awareness over time.It also lacked exploration of reasons behind observed associations, impacting future evidence-based action plans.

Conclusions
This study revealed glaucoma awareness among adults in Taif City.Gender, education, and family history played significant roles in shaping awareness levels.There is a need for targeted educational efforts to improve knowledge about glaucoma in the community.This study underscores the importance of tailored glaucoma awareness campaigns, especially targeting men, less-educated individuals, and those lacking awareness about glaucoma.It emphasizes the crucial role of disseminating accurate information.Leveraging family history as a risk factor for targeted education and early detection is vital.These findings have significant implications for informing public health initiatives aimed at raising glaucoma awareness, focusing on old age and less-educated individuals, dispelling misconceptions, and highlighting the "silent" nature of the disease in the region.

FIGURE 1 :
FIGURE 1: Sources of information about glaucoma.

FIGURE 2 :
FIGURE 2: Perception of participants about glaucoma types.

FIGURE 3 :
FIGURE 3: Knowledge of participants about the cure of glaucoma.

FIGURE 4 :
FIGURE 4: Perception of participants about the factors that increase the risk of glaucoma.Correct answer: All the above factors can increase the risk for glaucoma except for the cosmetic use of makeup.Hx = history; DM = diabetes mellitus; HTN = hypertension

TABLE 2 : Assessment of knowledge of the different aspects of glaucoma of participants (n = 1,000).
*: Correct answers.

TABLE 3 : Associations of sociodemographic features with the awareness level of glaucoma (n = 1,000).
Sociodemographic factors such as age, gender, employment, family history, and smoking received 7.8% (n = 78) each.Comorbidities such as diabetes, hypertension, and obesity were noted by 12.1% (n = 121).Eyerelated and other factors such as trauma, myopia, steroids, and cosmetics use received lower attention (Figure4).